Patient satisfaction and perception of success after total knee arthroplasty are more strongly associated with patient factors and complications than surgical or anaesthetic factors

  • 49 Accesses



A proportion of TKA recipients following TKA are dissatisfied with their outcome. Our hypothesis is that patient satisfaction with TKA and perception of success of surgery are associated with patient comorbidities and overall health status, surgical and anaesthetic techniques as well as processes of post-operative care after TKA. The aims were to (i) measure the incidence of patient unfavourable outcomes—defined as dissatisfaction with the surgery or lack of joint-specific global improvement—1 year after TKA, and to explore the differences between these two outcomes of interest; (ii) assess the relationship between the development of these unfavourable outcomes and patient-reported knee function and overall quality of life; (iii) explore the associations between pre- and peri-operative variables and the development of these unfavourable outcomes 1 year after TKA.


This study includes analysis of data from a prospective cohort of 1017 TKA recipients. Pre-operative patient variables, surgical and acute-care data were collected. The Oxford knee score and the global perception of improvement were used to assess satisfaction and success 365 days post-surgery.


From 1017 patients (56% female), mean age 68 years and BMI 32, 68 pts (7%) were dissatisfied with the outcome of surgery, 141 pts (14%) believed surgery was unsuccessful 1 year after TKA. A negative outcome was noted in 151 (15%) patients for either satisfaction or success, and 58 (6%) of patients reported neither good satisfaction nor success after surgery. Dissatisfied patients reported worse mean OKS (26.4 [SD 8.03] vs 42.3 [SD 5.21], p < 0.001) and mean EQ VAS (64.9 [SD 19.49] vs 81.8 [SD 14.38], p < 0.001) than satisfied patients. Patients who reported unsuccessful surgery also showed significantly lower mean OKS (30.9 [SD 9.29] vs 42.9 [SD 4.39], p < 0.001) and mean EQ VAS (68.2 [SD 18.61] vs 82.7 [SD 13.77], p < 0.001). Univariate analysis of predictors of unfavourable outcome post-TKA showed that financial status, obstructive sleep apnoea (OSA), ASA class > 2 and not resurfacing the patella were factors associated with the development of dissatisfaction with TKA and with patient perceived unsuccessful results of TKA. Multivariable logistic regression of patient satisfaction and success of TKA showed that compensation cases (OR 26.91, p < 0.001 for dissatisfaction and OR 11.49, p = 0.001 for unsuccessful TKA), obstructive sleep apnoea (OR 2.18, p = 0.04 for dissatisfaction and OR 1.82, p = 0.04 for unsuccessful TKA), ASA grade > 2 (OR 1.83, p = 0.04 for dissatisfaction and OR 1.57, p = 0.03 for unsuccessful TKA)and the development of a complication after TKA (OR 3.4, p < 0.001 for dissatisfaction and OR 2.39, p < 0.001 for unsuccessful TKA) were associated with the development of a negative outcome in both groups. Patella preservation (OR 1.96, p = 0.03) was associated with dissatisfaction, whereas the use of cruciate retaining femoral prosthesis was associated with less successful results of TKA (OR 1.78, p = 0.009).


An unfavourable outcome occurs in approximately 7–15% of patients following TKA. The incidence varies with how an unfavourable result is defined and many factors are associated with this outcome though prosthetic design or patella resurfacing do not appear to be important.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.


  1. 1.

    Ali A, Sundberg M, Robertsson O, Dahlberg LE, Thorstensson CA, Redlund-Johnell I et al (2014) Dissatisfied patients after total knee arthroplasty: a registry study involving 114 patients with 8–13 years of follow-up. Acta orthop 85:229–233

  2. 2.

    Becker R, Doring C, Denecke A, Brosz M (2011) Expectation, satisfaction and clinical outcome of patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19:1433–1441

  3. 3.

    Berend KR, Ajluni AF, Nunez-Garcia LA, Lombardi AV, Adams JB (2010) Prevalence and management of obstructive sleep apnea in patients undergoing total joint arthroplasty. J Arthroplasty 25:54–57

  4. 4.

    Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2:e000435

  5. 5.

    Bonnin MP, Basiglini L, Archbold HA (2011) What are the factors of residual pain after uncomplicated TKA? Knee Surg Sports Traumatol Arthrosc 19:1411–1417

  6. 6.

    Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

  7. 7.

    Brander V, Gondek S, Martin E, Stulberg SD (2007) Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 464:21–26

  8. 8.

    Chua MJ, Hart AJ, Mittal R, Harris IA, Xuan W, Naylor JM (2017) Early mobilisation after total hip or knee arthroplasty: a multicentre prospective observational study. PLoS One 12:e0179820

  9. 9.

    Clement ND, Bardgett M, Weir D, Holland J, Gerrand C, Deehan DJ (2018) The rate and predictors of patient satisfaction after total knee arthroplasty are influenced by the focus of the question. Bone Jt J 100-B:740–748

  10. 10.

    Dang KLT, Badge H, Harris IA (2018) Validity of patient-reported complications after total hip and knee arthroplasty. J Orthop Surg 26:1–5

  11. 11.

    Dawson J, Fitzpatrick R, Murray D, Carr A (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Jt Surg Br 80-B:63–69

  12. 12.

    Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW (2017) Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 32:3854–3860

  13. 13.

    Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D et al (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736

  14. 14.

    Hirschmann MT, Testa E, Amsler F, Friederich NF (2013) The unhappy total knee arthroplasty (TKA) patient: higher WOMAC and lower KSS in depressed patients prior and after TKA. Knee Surg Sports Traumatol Arthrosc 21:2405–2411

  15. 15.

    Jenkins PJ, Clement ND, Hamilton DF, Gaston P, Patton JT, Howie CR (2013) Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Jt J 95-B:115–121

  16. 16.

    Judge A, Arden NK, Cooper C, Kassim Javaid M, Carr AJ, Field RE et al (2012) Predictors of outcomes of total knee replacement surgery. Rheumatology 51:1804–1813

  17. 17.

    Kamper SJ, Ostelo RWJG, Knol DL, Maher CG, de Vet HCW, Hancock MJ (2010) Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status. J Clin Epidemiol 63:760–766

  18. 18.

    Khatib YMA, Naylor JM, Harris IA (2015) Do psychological factors predict poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res 473:2630–2638

  19. 19.

    Mayer M, Naylor J, Harris I, Badge H, Adie S, Mills K et al (2017) Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries. PLoS One 12:e0180090

  20. 20.

    Naylor JM, Descallar J, Grootemaat M, Badge H, Harris IA, Simpson G et al (2016) Is satisfaction with the acute-care experience higher amongst consumers treated in the private sector? A survey of public and private sector arthroplasty recipients. PLoS One 11:e0159799

  21. 21.

    Naylor JM, Hart A, Harris IA, Lewin AM (2019) Variation in rehabilitation setting after uncomplicated total knee or hip arthroplasty: a call for evidence-based guidelines. BMC Musculoskel Dis 20:214

  22. 22.

    Naylor JM, Hart A, Mittal R, Harris I, Xuan W (2017) The value of inpatient rehabilitation after uncomplicated knee arthroplasty: a propensity score analysis. Med J Aus 207:250–255

  23. 23.

    NHS Digital (2019) Finalised patient reported outcome measures (PROMs) in England for hip and knee replacement procedures (April 2017 to March 2018). April-2017-to-March-2018, April 2019. Accessed 28 Mar 2019

  24. 24.

    Noble PC, Conditt MA, Cook KF, Mathis KB (2006) Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 452:35–43

  25. 25.

    Rothwell AG, Hooper GJ, Hobbs A, Frampton CM (2010) An analysis of the Oxford hip and knee scores and their relationship to early joint revision in the New Zealand Joint Registry. J Bone Jt Surg Br 92:413–418

  26. 26.

    Weber M, Craiovan B, Woerner ML, Schwarz T, Grifka J, Renkawitz TF (2018) Predictors of outcome after primary total joint replacement. J Arthroplasty 33:431–435

  27. 27.

    Wylde V, Bruce J, Beswick A, Elvers K, Gooberman-Hill R (2013) Assessment of chronic postsurgical pain after knee replacement: a systematic review. Arthritis care res 65:1795–1803

Download references

Author information

Correspondence to Yasser Khatib.

Ethics declarations


No external funding was recieved for the conduct of this study.

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licencing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 19 kb)

Supplementary file2 (DOCX 19 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Khatib, Y., Badge, H., Xuan, W. et al. Patient satisfaction and perception of success after total knee arthroplasty are more strongly associated with patient factors and complications than surgical or anaesthetic factors. Knee Surg Sports Traumatol Arthrosc (2020) doi:10.1007/s00167-019-05804-9

Download citation


  • Total knee arthroplasty
  • Outcomes
  • Function
  • Patient satisfaction
  • Prognosis